After Hepatitis Case, State Acts to Speed Alerts to Patients at Risk

Thursday

Nov 29, 2007 at 5:21 AM

The state health commissioner has proposed a series of changes to help prevent delays in notifying patients who may be exposed to various infections in case a doctor’s infection-control practices are faulty.

After coming under blistering criticism for a nearly three-year delay in notifying patients who might have been exposed to hepatitis C because of a Long Island doctor’s poor infection-control practices, the state health commissioner, Dr. Richard F. Daines, has proposed a series of internal changes to prevent such delays in the future.

Dr. Daines said in an interview yesterday that he was putting together a task force that would report to him with monthly updates on all open investigations into doctors’ practices, with reports from various divisions of the department that had not previously coordinated their efforts.

“There did not appear to be a formal way that that would come up to the level of the commissioner,” he said yesterday. “It’s unfortunate it took so long.”

He also said the department might become more aggressive in obtaining doctors’ medical records in such cases.

It took the State Health Department 34 months to tell 628 patients of Dr. Harvey S. Finkelstein, an anesthesiologist who was found to have injected patients with medicine from contaminated multiple-dose vials, that they should be tested for two types of hepatitis and H.I.V.

Dr. Finkelstein’s faulty practice led to at least one transmission of hepatitis C from one of his patients to another, and Nassau County health officials said they were investigating a case of hepatitis B to determine whether it could be linked to Dr. Finkelstein.

Dr. Daines said the long delay was the result of a careful, painstaking and “first-rate” investigation into how the patients, who all received epidural injections for pain, might have been exposed to infection.

The commissioner’s proposed changes were reported by Newsday yesterday.

Among the proposed changes, Dr. Daines said, is an effort to coordinate the work of officials who focus on the professional conduct of doctors, public health scares, like hepatitis C infection, and medical malpractice suits.

In Dr. Finkelstein’s case, one part of the department was looking into how the hepatitis C transmission occurred, but it was months later — and only after a patient complained — that the department’s Office of Professional Medical Conduct, which investigates and disciplines doctors, took up the case. Under state law, those investigations are not open to the public until they are concluded.

The medical conduct office, which found no evidence of wrongdoing and recommended no disciplinary action against Dr. Finkelstein, receives about 8,000 complaints a year, resulting in about 400 active investigations, Dr. Daines said.

Meanwhile, there was no discussion in the course of either investigation about Dr. Finkelstein’s unusually high number of malpractice suits — 10 settlements in the last 10 years, according to public records — which put him in what insurers call a “high risk” category, Dr. Daines said.

While information on malpractice cases and settlements is available to the public on the medical conduct office’s Web site, it has not been part of the state’s evaluation of doctors whose practices have been called into question, Dr. Daines said.

He said the department was considering whether — and when — to notify the public about doctors’ malpractice histories. He added that malpractice insurance premiums, which have skyrocketed in the last several years, are themselves a form of free-market disciplinary action.

Patient advocates, who — along with Nassau County officials and Gov. Eliot Spitzer — were deeply critical of the Health Department’s handling of the case, said they were cautiously encouraged by Dr. Daines’s proposed changes.

“I think at this point there’s no reason not to think that Commissioner Daines is genuine in his concern and that he really wants to fix what’s broken,” said Arthur Levin, director of the Center for Medical Consumers in New York City. “Like many of us looking at this very bizarre episode, it is less important for the specifics of what happened than it is for shining a light on what systemically may be a problem.”

Also at issue in the Finkelstein case was the time the doctor took to give his records to state health officials. He had been asked to do so voluntarily. Dr. Daines said the department was looking into ways health officials could be more aggressive in obtaining medical records, under subpoena if necessary, which should be easier with many doctors moving to electronic record keeping. But he said there were no policy changes in the offing on obtaining records.

Dr. Daines also said he was interested in loosening confidentiality rules about naming doctors and making the confidential investigations into charges against them more transparent.

State law, however, requires the department to keep the identity of a doctor confidential until the conclusion of an investigation. The law was challenged, but in 1993 an appeals court upheld it, and said that any changes would have to be made by the State Legislature.